Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

POTASSIUM CHLORIDE 2 MEQ/ML INTRAVENOUS SOLUTION (TPN COMPONENT)

Facility

$668.75

Service Code	HCPCS J3480
Hospital Charge Code	300444
Hospital Revenue Code	636
Min. Negotiated Rate	$421.31
Max. Negotiated Rate	$601.88
Rate for Payer: Aetna Commercial	$568.44
Rate for Payer: Aetna New Business (MI Preferred)	$434.69
Rate for Payer: Cash Price	$535.00
Rate for Payer: Cofinity Commercial	$468.12
Rate for Payer: Cofinity Commercial	$575.12
Rate for Payer: Cofinity Medicare Advantage	$468.12
Rate for Payer: Encore Health Key Benefits Commercial	$535.00
Rate for Payer: Healthscope Commercial	$601.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$568.44
Rate for Payer: PHP Commercial	$568.44
Rate for Payer: Priority Health Cigna Priority Health	$434.69
Rate for Payer: Priority Health SBD	$421.31

POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE

Facility

$291.84

Service Code	NDC 00904693061
Hospital Charge Code	13644
Hospital Revenue Code	637
Min. Negotiated Rate	$116.74
Max. Negotiated Rate	$262.66
Rate for Payer: Aetna Commercial	$248.06
Rate for Payer: Aetna Medicare	$145.92
Rate for Payer: Aetna New Business (MI Preferred)	$189.70
Rate for Payer: BCBS Complete	$116.74
Rate for Payer: Cash Price	$233.47
Rate for Payer: Cofinity Commercial	$204.29
Rate for Payer: Cofinity Commercial	$250.98
Rate for Payer: Cofinity Medicare Advantage	$204.29
Rate for Payer: Encore Health Key Benefits Commercial	$233.47
Rate for Payer: Healthscope Commercial	$262.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.06
Rate for Payer: PHP Commercial	$248.06
Rate for Payer: Priority Health Cigna Priority Health	$189.70
Rate for Payer: Priority Health SBD	$183.86

POTASSIUM CHLORIDE ER 10 MEQ CAPSULE,EXTENDED RELEASE

Facility

$291.84

Service Code	NDC 00904693061
Hospital Charge Code	13644
Hospital Revenue Code	637
Min. Negotiated Rate	$183.86
Max. Negotiated Rate	$262.66
Rate for Payer: Aetna Commercial	$248.06
Rate for Payer: Aetna New Business (MI Preferred)	$189.70
Rate for Payer: Cash Price	$233.47
Rate for Payer: Cofinity Commercial	$204.29
Rate for Payer: Cofinity Commercial	$250.98
Rate for Payer: Cofinity Medicare Advantage	$204.29
Rate for Payer: Encore Health Key Benefits Commercial	$233.47
Rate for Payer: Healthscope Commercial	$262.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$248.06
Rate for Payer: PHP Commercial	$248.06
Rate for Payer: Priority Health Cigna Priority Health	$189.70
Rate for Payer: Priority Health SBD	$183.86

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$242.25

Service Code	NDC 60687046601
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$152.62
Max. Negotiated Rate	$218.02
Rate for Payer: Aetna Commercial	$205.91
Rate for Payer: Aetna New Business (MI Preferred)	$157.46
Rate for Payer: Cash Price	$193.80
Rate for Payer: Cofinity Commercial	$169.58
Rate for Payer: Cofinity Commercial	$208.34
Rate for Payer: Cofinity Medicare Advantage	$169.58
Rate for Payer: Encore Health Key Benefits Commercial	$193.80
Rate for Payer: Healthscope Commercial	$218.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.91
Rate for Payer: PHP Commercial	$205.91
Rate for Payer: Priority Health Cigna Priority Health	$157.46
Rate for Payer: Priority Health SBD	$152.62

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$242.25

Service Code	NDC 60687046601
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$96.90
Max. Negotiated Rate	$218.02
Rate for Payer: Aetna Commercial	$205.91
Rate for Payer: Aetna Medicare	$121.12
Rate for Payer: Aetna New Business (MI Preferred)	$157.46
Rate for Payer: BCBS Complete	$96.90
Rate for Payer: Cash Price	$193.80
Rate for Payer: Cofinity Commercial	$169.58
Rate for Payer: Cofinity Commercial	$208.34
Rate for Payer: Cofinity Medicare Advantage	$169.58
Rate for Payer: Encore Health Key Benefits Commercial	$193.80
Rate for Payer: Healthscope Commercial	$218.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.91
Rate for Payer: PHP Commercial	$205.91
Rate for Payer: Priority Health Cigna Priority Health	$157.46
Rate for Payer: Priority Health SBD	$152.62

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$227.95

Service Code	NDC 70010002201
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$143.61
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Commercial	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Cofinity Medicare Advantage	$159.56
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health Cigna Priority Health	$148.17
Rate for Payer: Priority Health SBD	$143.61

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$2.69

Service Code	NDC 00574027500
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.69
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna New Business (MI Preferred)	$1.75
Rate for Payer: Cash Price	$2.15
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.31
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.15
Rate for Payer: Healthscope Commercial	$2.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.29
Rate for Payer: PHP Commercial	$2.29
Rate for Payer: Priority Health Cigna Priority Health	$1.75
Rate for Payer: Priority Health SBD	$1.69

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$311.60

Service Code	NDC 00245531601
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$196.31
Max. Negotiated Rate	$280.44
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna New Business (MI Preferred)	$202.54
Rate for Payer: Cash Price	$249.28
Rate for Payer: Cofinity Commercial	$218.12
Rate for Payer: Cofinity Commercial	$267.98
Rate for Payer: Cofinity Medicare Advantage	$218.12
Rate for Payer: Encore Health Key Benefits Commercial	$249.28
Rate for Payer: Healthscope Commercial	$280.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.86
Rate for Payer: PHP Commercial	$264.86
Rate for Payer: Priority Health Cigna Priority Health	$202.54
Rate for Payer: Priority Health SBD	$196.31

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$268.85

Service Code	NDC 00574027511
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$107.54
Max. Negotiated Rate	$241.96
Rate for Payer: Aetna Commercial	$228.52
Rate for Payer: Aetna Medicare	$134.42
Rate for Payer: Aetna New Business (MI Preferred)	$174.75
Rate for Payer: BCBS Complete	$107.54
Rate for Payer: Cash Price	$215.08
Rate for Payer: Cofinity Commercial	$188.20
Rate for Payer: Cofinity Commercial	$231.21
Rate for Payer: Cofinity Medicare Advantage	$188.20
Rate for Payer: Encore Health Key Benefits Commercial	$215.08
Rate for Payer: Healthscope Commercial	$241.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.52
Rate for Payer: PHP Commercial	$228.52
Rate for Payer: Priority Health Cigna Priority Health	$174.75
Rate for Payer: Priority Health SBD	$169.38

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$2.69

Service Code	NDC 00574027500
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$2.42
Rate for Payer: Aetna Commercial	$2.29
Rate for Payer: Aetna Medicare	$1.34
Rate for Payer: Aetna New Business (MI Preferred)	$1.75
Rate for Payer: BCBS Complete	$1.08
Rate for Payer: Cash Price	$2.15
Rate for Payer: Cofinity Commercial	$1.88
Rate for Payer: Cofinity Commercial	$2.31
Rate for Payer: Cofinity Medicare Advantage	$1.88
Rate for Payer: Encore Health Key Benefits Commercial	$2.15
Rate for Payer: Healthscope Commercial	$2.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.29
Rate for Payer: PHP Commercial	$2.29
Rate for Payer: Priority Health Cigna Priority Health	$1.75
Rate for Payer: Priority Health SBD	$1.69

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$2.43

Service Code	NDC 60687046611
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna Medicare	$1.22
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: BCBS Complete	$0.97
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Medicare Advantage	$1.70
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.58
Rate for Payer: Priority Health SBD	$1.53

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$260.85

Service Code	NDC 00832532311
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$164.34
Max. Negotiated Rate	$234.76
Rate for Payer: Aetna Commercial	$221.72
Rate for Payer: Aetna New Business (MI Preferred)	$169.55
Rate for Payer: Cash Price	$208.68
Rate for Payer: Cofinity Commercial	$182.60
Rate for Payer: Cofinity Commercial	$224.33
Rate for Payer: Cofinity Medicare Advantage	$182.60
Rate for Payer: Encore Health Key Benefits Commercial	$208.68
Rate for Payer: Healthscope Commercial	$234.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.72
Rate for Payer: PHP Commercial	$221.72
Rate for Payer: Priority Health Cigna Priority Health	$169.55
Rate for Payer: Priority Health SBD	$164.34

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$260.85

Service Code	NDC 00832532311
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$104.34
Max. Negotiated Rate	$234.76
Rate for Payer: Aetna Commercial	$221.72
Rate for Payer: Aetna Medicare	$130.42
Rate for Payer: Aetna New Business (MI Preferred)	$169.55
Rate for Payer: BCBS Complete	$104.34
Rate for Payer: Cash Price	$208.68
Rate for Payer: Cofinity Commercial	$182.60
Rate for Payer: Cofinity Commercial	$224.33
Rate for Payer: Cofinity Medicare Advantage	$182.60
Rate for Payer: Encore Health Key Benefits Commercial	$208.68
Rate for Payer: Healthscope Commercial	$234.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$221.72
Rate for Payer: PHP Commercial	$221.72
Rate for Payer: Priority Health Cigna Priority Health	$169.55
Rate for Payer: Priority Health SBD	$164.34

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$227.95

Service Code	NDC 70010002201
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$91.18
Max. Negotiated Rate	$205.16
Rate for Payer: Aetna Commercial	$193.76
Rate for Payer: Aetna Medicare	$113.98
Rate for Payer: Aetna New Business (MI Preferred)	$148.17
Rate for Payer: BCBS Complete	$91.18
Rate for Payer: Cash Price	$182.36
Rate for Payer: Cofinity Commercial	$159.56
Rate for Payer: Cofinity Commercial	$196.04
Rate for Payer: Cofinity Medicare Advantage	$159.56
Rate for Payer: Encore Health Key Benefits Commercial	$182.36
Rate for Payer: Healthscope Commercial	$205.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$193.76
Rate for Payer: PHP Commercial	$193.76
Rate for Payer: Priority Health Cigna Priority Health	$148.17
Rate for Payer: Priority Health SBD	$143.61

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$268.85

Service Code	NDC 00574027511
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$169.38
Max. Negotiated Rate	$241.96
Rate for Payer: Aetna Commercial	$228.52
Rate for Payer: Aetna New Business (MI Preferred)	$174.75
Rate for Payer: Cash Price	$215.08
Rate for Payer: Cofinity Commercial	$188.20
Rate for Payer: Cofinity Commercial	$231.21
Rate for Payer: Cofinity Medicare Advantage	$188.20
Rate for Payer: Encore Health Key Benefits Commercial	$215.08
Rate for Payer: Healthscope Commercial	$241.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$228.52
Rate for Payer: PHP Commercial	$228.52
Rate for Payer: Priority Health Cigna Priority Health	$174.75
Rate for Payer: Priority Health SBD	$169.38

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$2.43

Service Code	NDC 60687046611
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$1.53
Max. Negotiated Rate	$2.19
Rate for Payer: Aetna Commercial	$2.07
Rate for Payer: Aetna New Business (MI Preferred)	$1.58
Rate for Payer: Cash Price	$1.94
Rate for Payer: Cofinity Commercial	$1.70
Rate for Payer: Cofinity Commercial	$2.09
Rate for Payer: Cofinity Medicare Advantage	$1.70
Rate for Payer: Encore Health Key Benefits Commercial	$1.94
Rate for Payer: Healthscope Commercial	$2.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.07
Rate for Payer: PHP Commercial	$2.07
Rate for Payer: Priority Health Cigna Priority Health	$1.58
Rate for Payer: Priority Health SBD	$1.53

POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE

Facility

$311.60

Service Code	NDC 00245531601
Hospital Charge Code	6436
Hospital Revenue Code	637
Min. Negotiated Rate	$124.64
Max. Negotiated Rate	$280.44
Rate for Payer: Aetna Commercial	$264.86
Rate for Payer: Aetna Medicare	$155.80
Rate for Payer: Aetna New Business (MI Preferred)	$202.54
Rate for Payer: BCBS Complete	$124.64
Rate for Payer: Cash Price	$249.28
Rate for Payer: Cofinity Commercial	$218.12
Rate for Payer: Cofinity Commercial	$267.98
Rate for Payer: Cofinity Medicare Advantage	$218.12
Rate for Payer: Encore Health Key Benefits Commercial	$249.28
Rate for Payer: Healthscope Commercial	$280.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$264.86
Rate for Payer: PHP Commercial	$264.86
Rate for Payer: Priority Health Cigna Priority Health	$202.54
Rate for Payer: Priority Health SBD	$196.31

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$5.63

Service Code	NDC 09900001948
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Aetna New Business (MI Preferred)	$3.66
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.94
Rate for Payer: Cofinity Commercial	$4.84
Rate for Payer: Cofinity Medicare Advantage	$3.94
Rate for Payer: Encore Health Key Benefits Commercial	$4.50
Rate for Payer: Healthscope Commercial	$5.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.79
Rate for Payer: PHP Commercial	$4.79
Rate for Payer: Priority Health Cigna Priority Health	$3.66
Rate for Payer: Priority Health SBD	$3.55

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$5.63

Service Code	NDC 09900001948
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$5.07
Rate for Payer: Aetna Commercial	$4.79
Rate for Payer: Aetna Medicare	$2.82
Rate for Payer: Aetna New Business (MI Preferred)	$3.66
Rate for Payer: BCBS Complete	$2.25
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cofinity Commercial	$3.94
Rate for Payer: Cofinity Commercial	$4.84
Rate for Payer: Cofinity Medicare Advantage	$3.94
Rate for Payer: Encore Health Key Benefits Commercial	$4.50
Rate for Payer: Healthscope Commercial	$5.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.79
Rate for Payer: PHP Commercial	$4.79
Rate for Payer: Priority Health Cigna Priority Health	$3.66
Rate for Payer: Priority Health SBD	$3.55

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$78.44

Service Code	NDC 00178031430
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$49.42
Max. Negotiated Rate	$70.60
Rate for Payer: Aetna Commercial	$66.67
Rate for Payer: Aetna New Business (MI Preferred)	$50.99
Rate for Payer: Cash Price	$62.75
Rate for Payer: Cofinity Commercial	$54.91
Rate for Payer: Cofinity Commercial	$67.46
Rate for Payer: Cofinity Medicare Advantage	$54.91
Rate for Payer: Encore Health Key Benefits Commercial	$62.75
Rate for Payer: Healthscope Commercial	$70.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.67
Rate for Payer: PHP Commercial	$66.67
Rate for Payer: Priority Health Cigna Priority Health	$50.99
Rate for Payer: Priority Health SBD	$49.42

POTASSIUM IODIDE 65 MG/ML ORAL DROPS

Facility

$78.44

Service Code	NDC 00178031430
Hospital Charge Code	113247
Hospital Revenue Code	637
Min. Negotiated Rate	$31.38
Max. Negotiated Rate	$70.60
Rate for Payer: Aetna Commercial	$66.67
Rate for Payer: Aetna Medicare	$39.22
Rate for Payer: Aetna New Business (MI Preferred)	$50.99
Rate for Payer: BCBS Complete	$31.38
Rate for Payer: Cash Price	$62.75
Rate for Payer: Cofinity Commercial	$54.91
Rate for Payer: Cofinity Commercial	$67.46
Rate for Payer: Cofinity Medicare Advantage	$54.91
Rate for Payer: Encore Health Key Benefits Commercial	$62.75
Rate for Payer: Healthscope Commercial	$70.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.67
Rate for Payer: PHP Commercial	$66.67
Rate for Payer: Priority Health Cigna Priority Health	$50.99
Rate for Payer: Priority Health SBD	$49.42

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$431.09

Service Code	NDC 46287002410
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$172.44
Max. Negotiated Rate	$387.98
Rate for Payer: Aetna Commercial	$366.43
Rate for Payer: Aetna Medicare	$215.54
Rate for Payer: Aetna New Business (MI Preferred)	$280.21
Rate for Payer: BCBS Complete	$172.44
Rate for Payer: Cash Price	$344.87
Rate for Payer: Cofinity Commercial	$301.76
Rate for Payer: Cofinity Commercial	$370.74
Rate for Payer: Cofinity Medicare Advantage	$301.76
Rate for Payer: Encore Health Key Benefits Commercial	$344.87
Rate for Payer: Healthscope Commercial	$387.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.43
Rate for Payer: PHP Commercial	$366.43
Rate for Payer: Priority Health Cigna Priority Health	$280.21
Rate for Payer: Priority Health SBD	$271.59

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$431.09

Service Code	NDC 46287002410
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$271.59
Max. Negotiated Rate	$387.98
Rate for Payer: Aetna Commercial	$366.43
Rate for Payer: Aetna New Business (MI Preferred)	$280.21
Rate for Payer: Cash Price	$344.87
Rate for Payer: Cofinity Commercial	$301.76
Rate for Payer: Cofinity Commercial	$370.74
Rate for Payer: Cofinity Medicare Advantage	$301.76
Rate for Payer: Encore Health Key Benefits Commercial	$344.87
Rate for Payer: Healthscope Commercial	$387.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.43
Rate for Payer: PHP Commercial	$366.43
Rate for Payer: Priority Health Cigna Priority Health	$280.21
Rate for Payer: Priority Health SBD	$271.59

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$431.09

Service Code	NDC 46287002415
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$271.59
Max. Negotiated Rate	$387.98
Rate for Payer: Aetna Commercial	$366.43
Rate for Payer: Aetna New Business (MI Preferred)	$280.21
Rate for Payer: Cash Price	$344.87
Rate for Payer: Cofinity Commercial	$301.76
Rate for Payer: Cofinity Commercial	$370.74
Rate for Payer: Cofinity Medicare Advantage	$301.76
Rate for Payer: Encore Health Key Benefits Commercial	$344.87
Rate for Payer: Healthscope Commercial	$387.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.43
Rate for Payer: PHP Commercial	$366.43
Rate for Payer: Priority Health Cigna Priority Health	$280.21
Rate for Payer: Priority Health SBD	$271.59

POTASSIUM PHOS-MONO-DIBASIC 3 MMOL/ML (4.7 MEQ POTASSIUM/ML) IV SOLN

Facility

$431.09

Service Code	NDC 46287002415
Hospital Charge Code	193046
Hospital Revenue Code	250
Min. Negotiated Rate	$172.44
Max. Negotiated Rate	$387.98
Rate for Payer: Aetna Commercial	$366.43
Rate for Payer: Aetna Medicare	$215.54
Rate for Payer: Aetna New Business (MI Preferred)	$280.21
Rate for Payer: BCBS Complete	$172.44
Rate for Payer: Cash Price	$344.87
Rate for Payer: Cofinity Commercial	$301.76
Rate for Payer: Cofinity Commercial	$370.74
Rate for Payer: Cofinity Medicare Advantage	$301.76
Rate for Payer: Encore Health Key Benefits Commercial	$344.87
Rate for Payer: Healthscope Commercial	$387.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$366.43
Rate for Payer: PHP Commercial	$366.43
Rate for Payer: Priority Health Cigna Priority Health	$280.21
Rate for Payer: Priority Health SBD	$271.59

Know your out-of-pocket cost for care.

All Charges